Healthcare Provider Details

I. General information

NPI: 1699604264
Provider Name (Legal Business Name): JASMINE ROSE DECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 844
ALBANY OR
97321-0305
US

IV. Provider business mailing address

PO BOX 844
ALBANY OR
97321-0305
US

V. Phone/Fax

Practice location:
  • Phone: 541-619-4160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: